| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Squint, close or cover one eye while reading |
|
X |
|
|
| Tilt head in an unusual posture when reading or writing |
|
X |
|
|
| Headaches after intense visual activities such as reading or computer work |
X |
X |
X |
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Poor spelling skills |
|
|
|
X |
| Letters or lines “run together” or words appear to “jump” when reading |
X |
X |
|
|
| Difficulty tracking moving objects |
X |
X |
|
|
| Clumsiness or poor coordination |
X |
X |
X |
X |
| Unable to make a picture in your mind while reading |
|
|
|
X |
| Dislike tasks requiring sustained concentration |
X |
X |
X |
X |
| Avoid near tasks such as reading |
X |
X |
X |
|
| Confuse right and left directions |
|
|
|
X |
| Sensitivity to light |
X |
X |
X |
|
| Red eyes |
X |
X |
X |
|
| Totals |
27 |
33 |
15 |
13 |
| Maximum Possible |
69 |
84 |
54 |
55 |
